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Brief Symptom Inventory

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Purpose

The BSI evaluates psychological distress and psychiatric disorders in people. It collects data reported by patients for the evaluation. The test can be used for areas such as patient progress, treatment measurements, and psychological assessment.

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Instrument Details

Acronym BSI

Area of Assessment

Behavior
Cognition
Depression
Personality
Social Relationships
Mental Health

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$124.00

Cost Description

BSI hand-scoring starter kit costs $124.

Diagnosis/Conditions

  • Brain Injury

Key Descriptions

  • A 53-item patient reported 5-point (0-5) Likert-type scale measuring the extent to which individuals have been disturbed by certain mental health symptoms.
  • Self-report or interview administered via paper and pencil or computer administration.
  • Final score reported into separate subscales.
  • Reports client symptomatology across 9 domains:
    1) Somatization
    2) Obsessive compulsive
    3) Interpersonal sensitivity
    4) Depression
    5) Anxiety
    6) Hostility
    7) Phobia
    8) Paranoia
    9) Psychoticism

Number of Items

53

Equipment Required

  • Paper & Pencil for Standard Administration
  • Computer, Keyboard, and Mouse for Computerized Administration

Time to Administer

10-15 minutes

Required Training

Training Course

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Timothy P. Janikowski, PhD and his University at Buffalo Rehabilitation Counseling Master’s students, Kellie Talebkhah & Chad Nordin (4/27/2015).

ICF Domain

Activity
Participation

Measurement Domain

Cognition
Emotion

Considerations

BSI as a self-reported measure, thus results can be swayed by patients accurate reporting and subjectivity in responses. BSI as an interviewer administered measure can be influenced as well as social desirability. Authors reported high reliability and acceptability of BSI as an accurate measure of symptomatology. Shortened versions make for easy administration with consistent result. GSI score is very useful when assessing a patient for psychological distress, but not for psychiatric diagnoses (Asner-Self et al., 2006). Too general for assessing psychological distress for medically complex samples (Meachen et al., 2008).

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Mixed Populations

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Standard Error of Measurement (SEM)

Depression (Mohammadkhani et al. 2010; n=354)

  • SEM=.665 (GSI)

Cut-Off Scores

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • Depressive Symptoms: 0.28 or higher
  • Anxiety Symptoms: 0.35 or higher

 

Spanish Speaking (Asner-Self et al. 2006; n=100)

  • 0.40 to categorize strong versus weak loadings for factor analysis within each structures

Normative Data

(Derogatis, 1983) Adult non-patients (n=719), heterogeneous adult psychiatric outpatients (n=1002), psychiatric inpatients (n=313)

Test/Retest Reliability

Depression (Mohammadkhani et al. 2010; n=354)

 

Symptom Dimensions Range:

  • Adequate to Excellent: ICC= .68 (Somatization) to .91 (Phobia anxiety)

Three Global Indices:

  • Excellent: ICC= .87 (PSDI) to .90 (GSI)

 

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • Adequate to Excellent: ICC= .68 to .91

Internal Consistency

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • Adequate to Excellent: Cronbach's alpha= .71-.85

Depression (Mohammadkhani et al. 2010; n=354)

  • All subscales: Adequate to Excellent (Cronbach's alpha= .75-.87)

  • GSI: Excellent (Cronbach's alpha= .96)

**(Values >.90 may indicate redundancy)

 

Intellectual Disabilities (Wieland et al. 2012; n=224)

  • Adequate to Excellent (Cronbach's alpha= .70-.86)

  • BSI: Excellent (Cronbach's= .96)

Temporomandibular Disorders (Durá et al. 2006; n=114)

  • Subscales Adequate to Excellent: (Cronbach's alpha .73-.86)

  • BSI: Excellent (Cronbach's alpha .89)

College Students (Houghton et al. 2013; n=28)

  • Somatization: Poor (Cronbach's alpha= .52)

  • All other Subscales: Adequate to Excellent (Cronbach's alpha= .70-.87)

Chinese Drug Users (Wang et al. 2013; n=303)

  • Subscales: Adequate to Excellent (Cronbach's Alpha= .76-.83)

  • GSI: Excellent (Cronbach's alpha= .91)

** Values >.9 may indicate redundancy

Spanish Speaking (Asner-Self et al. 2006; n=100)

  • Subscales: Excellent (Cronbach's alpha= .81-.82)

  • GSI : Excellent (Cronbach's alpha= .91)

** Values >.9 may indicate redundancy

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Spanish Speaking (Asner-Self et al. 2006; n=100)

The separate dimensions tend to be good with other measures of distress such as the Minnesota Multiphasic Personality Inventory [MMPI].

Construct Validity

Convergent

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • SCL-90-R: Excellent (r=.92)

Depression (Mohammadkhani et al. 2010; n=354)

  • SCL-90-R: Excellent (r=.92)

Content Validity

The BSI was developed, in part, from content taken from the Symptom Checklist-90-R.

The Thorndike-Lorge Word Book (1944) was used to equate vocabulary levels of the 9 primary dimensions

Older Adults and Geriatric Care

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Cut-Off Scores

Homebound Older Adults (Petkus et al. 2010; n=142)

  • T-score of 63 indicating significant distress

Internal Consistency

Homebound Older Adults (Petkus et al. 2010; n=142)

  • Somatization: Poor (Cronbach's alpha= .69)

  • All other subscales: Excellent (Cronbach's alpha= .81-.89)

Face Validity

Homebound Older Adults (Petkus et al. 2010; n=142)

May have less face validity with homebound elders because the BSI does not contain items assessing suicide ideation or loneliness which are especially salient to homebound older adult populations.

Brain Injury

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Standard Error of Measurement (SEM)

Traumatic Brain Injury (Meachen et al. 2008; n=34)

  • SEM= .57 (GSI)

Test/Retest Reliability

Traumatic Brain Injury (Meachen et al. 2008; n=34)

  • GSI Adequate: ICC=.66

  • Somatization Adequate: ICC= .67

  • Depression Adequate: ICC= .63

  • Anxiety Adequate: ICC=.57 (P<.01)

Internal Consistency

Traumatic Brain Injury (Meachen et al. 2008; n=81 outpatient n=176 follow-up)

  • Excellent consistency for GSI follow-up participants (Cronbach’s alpha .91) and inpatients (Cronbach’s alpha .84)
  • Poor to Excellent consistency for subscales (Cronbach’s alpha= .61–.84)

Construct Validity

Traumatic Brain Injury (Meachen et al. 2008; n=81 outpatient n=176 follow-up)

  • NFI Depression: Excellent (r=.68)

  • NFI Aggression: Adequate (r=.55)

  • PANAS negative affectivity: Adequate (r=.49)

Cancer

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Cut-Off Scores

Breast Cancer (Galdón et al. 2008; n=175)

  • For general distress and anxiety

Internal Consistency

Breast Cancer (Galdón et al. 2008; n=175)

  • Subscales: Poor to Adequate (Cronbach's alpha= .62-.70)

Bibliography

Asner-Self, K.K., Schrieber, J.B., Marotta, S.A. (2006). A cross-cultural analysis of the Brief Symptom Inventory-18. Cultural Diversity and Ethnic Minority Psychology, 12 (2), 367-375.

Derogatis, L.R., Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine 13. 595-605.

Durá, E., Andreu, Y., Galdón, M. J., Ferrando, M., Murgui, S., Poveda, R., & Jimenes, Y. (2006). Psychological assessment of patients with temporomandibular disorders: Confirmatory analysis of the dimensional structure of the Brief Symptoms Inventory 18. Journal of Psychosomatic Research, 60(4), 365-370.

Galdón, M.J., Durá, E, Andreu, Y, Ferrando, M, Murgui, S, Pérez, S, Ibañez, E. (2008).  Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer  sample. Journal of Psychosomatic Research, 65(6). 533-539.

Houghton, F., Keane, N., Lewis, C.A., Murphy, N., Houghton, S., Dunne, C., (2013). Temporal stability of the Brief Symptom Inventory 18 among Irish college students over four weeks. Social Behavior and Personality, 41 (2), 197-198.

Khalil, A. A., Hall, L. A., Moser, D. K., Lennie, T. A., & Frazier, S. K. (2011). The psychometric properties of the Brief Symptom Inventory Depression and Anxiety subscales in patients with heart failure and with or without renal dysfunction. Archives of Psychiatric Nursing, 25(6), 419-429.

Meachen, S, Hanks, R.A., Millis, S.R., Rapport, L.J. (2008). The Reliability and Validity of the Brief Symptom Inventory-18 in Persons with Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 89(5), 958-965.

Mohammadkhani, P., Dobson, K. S., Amiri, M., & Ghafari, F. H. (2010). Psychometric properties of the Brief Symptom Inventory in a sample of recovered Iranian depressed patients. International Journal of Clinical and Health Psychology, 10(3), 541-551.

Petkus, A. J., Gum, A. M., Small, B., Malcarne, V. L., Stein, M. B. & Wetherell, J. L. (2010). Evaluation of the factor structure and psychometric properties of the Brief Symptom Inventory- 18 with homebound older adults. International Journal of Geriatric Psychiatry, 25(6), 578-587.

Wang, J, Kelly, B.C., Liu, T, Zhang, G, Hao, W. (2013). Factorial structure of the Brief   Symptom Inventory (BSI)-18 among Chinese drug users. Drug and Alcohol Dependence, 133(2), 368, 375.

Wieland, J., Wardenaar, K. J., Fontein, E., & Zitman, F. G. (2012). Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities. Journal of Intellectual Disability Research, 56(9), 843-853.

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